Summary: This lecture will cover diseases of the endometrium, myometrium, and
endometrial stroma, as well as endometriosis. The concept of hormonal imbalance in the
pathogenesis of abnormal uterine bleeding and infertility will be explored in conjunction
with the demonstration of morphologic findings in the endometrium in infertility,
hyperplasia, and adenocarcinoma of the endometrium. Mesenchymal tumors of the
uterus and their classifications both in terms of cell of origin and biologic behavior will
be presented. We will study the morphology and clinical significance of endometriosis,
as well as theories of its genesis.
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Gynecologic Pathology II
Pathology of the Uterus
D.Correlation of LMP date with histologic findings to look for “luteal phase defect”.
D.Clinical evaluation and biopsy used to exclude malignancy and hyperplasia and
determine if the patient requires either surgical or medical therapy.
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Gynecologic Pathology II
Pathology of the Uterus
Chlamydia
Postpartal or postabortal, generally with retained products of conception
IUD-Actinomyces
Tuberculosis
H.Endometrial hyperplasia
1.Architectural and sometimes cytologic disturbances of the endometrial glands
2.Potential for development of endometrial adenocarcinoma increases with higher
degrees of abnormality (especially cytologic abnormality)
3.Associated with sustained levels of unopposed estrogen stimulation:
polycystic ovarian disease, estrogen-secreting ovarian tumors, menopause, estrogen
replacement therapy, persistent anovulation, obesity.
4.Architectural abnormalities-simple vs. complex hyperplasia; if there is cytologic
atypia, it is called atypical hyperplasia
a.Simple hyperplasia-glands are cystically dilated while maintaining cellular
stratification and are crowded.
b.Complex hyperplasia-glands show greater crowding, greater variation in size and
shape, complex budding patterns
c.Cytologic atypia of the glandular cells-loss of polarity, nuclear irregularity,
increased N/C ration, prominent nucleoli, more frequent mitoses.
Atypical hyperplasia-may progress to endometrial adenocarcinoma in 25%.
d.It may be nearly impossible to distinguish atypical hyperplasia from adeno-
carcinoma on endometrial biopsies.
III.Endometrial Carcinoma
A.Virtually always presents with abnormal bleeding.
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Gynecologic Pathology II
Pathology of the Uterus
Type II:Generally occur in older patients than Type I, unassociated with the factors
noted for Type I, unassociated with hyperplasia
More aggressive disease, likely to present at a more advanced stage
Most common histologic type: papillary serous carcinoma;
others include clear cell
Much greater likelihood of dying of disease than Type I
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Gynecologic Pathology II
Pathology of the Uterus
E.The foci may cycle and bleed, which leads to scarring and, in the ovary, cyst
formation (“endometrioma”).
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